This short version of the interdisciplinary S3 guideline "Peri-and Postmenopause-Diagnosis and Interventions" is intended as a decision-making instrument for physicians who counsel peri-and postmenopausal women. It is designed to assist daily practice. The present short version summarizes the full version of the guideline which contains detailed information on guideline methodology, particularly regarding the critical appraisal of the evidence and the assignment of evidence levels. The statements and recommendations of the full version of the guideline are quoted completely in the present short version including levels of evidence (LoE) and grades of recommendation. The classification system developed by the Centre for Evidence-based Medicine in Oxford was used in this guideline.

Aim The aim of the interdisciplinary S3-guideline Perimenopause and Postmenopause – Diagnosis and Interventions is to provide help to physicians as they inform women about the physiological changes which occur at this stage of life and the treatment options. The guideline should serve as a basis for decisions taken during routine medical care. This short version lists the statements and recommendations given in the long version of the guideline together with the evidence levels, the level of recommendation, and the strength of consensus. Methods The statements and recommendations are largely based on methodologically high-quality publications. The literature was evaluated by experts and mandate holders using evidence-based medicine (EbM) criteria. The search for evidence was carried out by the Essen Research Institute for Medical Management (EsFoMed). To some extent, this guideline also draws on an evaluation of the evidence used in the NICE guideline on Menopause and the S3-guidelines of the AWMF and has adapted parts of these guidelines. Recommendations Recommendations are given for the following subjects: diagnosis and therapeutic interventions for perimenopausal and postmenopausal women, urogynecology, cardiovascular disease, osteoporosis, dementia, depression, mood swings, hormone therapy and cancer risk, as well as primary ovarian insufficiency.

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A systematic review was carried out based on a comprehensive literature search using Medline (years 1980–2000) and the Cochrane Database, covering the topic ‘hormone replacement therapy’ (HRT). Two hundred and forty published trials have been analyzed and evaluated based on their statistical and conceptual strength. Estrogen therapy leads to lower LDL cholesterol and a higher HDL/LDL ratio. Conjugated estrogen taken orally leads to higher triglyceride levels. Progestin, however, reduces the favorable effect of estrogen on serum lipids. Other surrogate parameters such as lipoprotein(a), homocysteine, blood pressure, vessel diameter measurements, Doppler ultrasound assessment, exercise ECG, parameters of carbohydrate metabolism or clotting factors may be favorably influenced by HRT, but they cannot prove a favorable effect on cardiovascular disease in general, as long as there is no proven mortality or morbidity benefit. In 1998, the Heart and Estrogen/progestin Replacement Study showed that women with preexisting cardiovascular disease receive no benefit from long-term (4–5 years) HRT, but have an increased rate of thromboembolism, especially in the first 4 months of treatment. No data exist about the influence of very long-term (>10 years) HRT on cardiovascular disease, either for healthy women or for women with preexisting cardiovascular disease. Very long-term HRT effects might be different from short-term effects. Hence, with regard to the prevention of cardiovascular disease, the following conclusions can be drawn: there are no reliable data to unequivocably prove the benefit of long-term HRT in healthy women. On the contrary, there is a 2- to 3-fold increased risk of thrombosis and embolism in the first months of treatment. Caution should therefore be exercised when using HRT, particularly with regard to the potentially harmful adverse effects.